The middle cerebral artery supplies the largest territory of any cerebral artery, including the primary motor and sensory cortices, Broca and Wernicke language areas, and the basal ganglia via the lenticulostriate perforators. MCA territory infarction from embolism or thrombosis produces the most common and debilitating ischaemic stroke pattern. The M1 segment is the most common target for endovascular thrombectomy because of its large territory and accessibility.
| Origin | Terminal division of the internal carotid artery |
|---|
MCA stroke produces contralateral face and arm weakness (more than leg because the leg cortex is medial and supplied by ACA), contralateral hemisensory loss, contralateral hemianopia, and dominant hemisphere aphasia or non-dominant neglect. NIHSS scoring guides treatment decisions. Mechanical thrombectomy for large vessel MCA occlusion within 24 hours of onset produces dramatically better outcomes than thrombolysis alone. Malignant MCA syndrome from hemispheric oedema requires decompressive hemicraniectomy to prevent transtentorial herniation.
Middle cerebral artery infarction producing contralateral hemiplegia, hemisensory loss, and aphasia or neglect managed with emergency thrombectomy for large vessel occlusion within 24 hours.
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